Abstrakt Gynekologie Leden 2012

GYN_Benign         (1)


Sait, K. H. (2011). “Early experience with the da vinci® surgical system robot in gynecological surgery at king abdulaziz university hospital.” Int J Womens Health 3(1): 219-226.

Background: The purpose of this study was to review our experience and the challenges of using the da Vinci® surgical system robot during gynecological surgery at King Abdulaziz University Hospital. Methods: A retrospective study was conducted to review all cases of robot-assisted gynecologic surgery performed at our institution between January 2008 and December 2010. The patients were reviewed for indications, complications, length of hospital stay, and conversion rate, as well as console and docking times. Results: Over the three-year period, we operated on 35 patients with benign or malignant conditions using the robot for a total of 62 surgical procedures. The docking times averaged seven minutes. The mean console times for simple hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic lymphadenectomy were 125, 47, and 62 minutes, respectively. In four patients, laparoscopic procedures were converted to open procedures, giving a conversion rate of 6.5%. All of the conversions were among the frst 15 procedures performed. The average hospital stay was 3 days. Complications occurred in fve patients (14%), and none were directly related to the robotic system. Conclusion: Our early experience with the robot show that with proper training of the robotic team, technical diffculty with the robotic system is limited. There is defnitely a learning curve that requires performance of gynecological surgical procedures using the robot. © 2011 Schindler, publisher and licensee Dove Medical Press Ltd.


GYN_Cancer         (6)


Dennis, T., C. de Mendonca, et al. (2012). “[Study of surplus cost of robotic assistance for radical hysterectomy, versus laparotomy and standard laparoscopy.].” Gynecologie, Obstetrique et Fertilite.

OBJECTIVES: The study purpose was to compare the costs among robotic, laparoscopic and open radical hysterectomy for cervical cancer. PATIENTS AND METHODS: Thirty-seven patients underwent robotic radical hysterectomy for cervical cancer. Cases were performed by three surgeons, at two institutions, and were retrospectively reviewed to perform a cost comparison between all three modalities. We included costs for edible materials in anesthesia and surgery, but costs for staff and indirect financial expenses were excluded. Those data are compared to open and laparoscopic radical hysterectomy data. RESULTS: The average cost for robotic assistance presented a surplus of 1796 euros compare to laparotomy and 1313 euros compare to standard laparoscopy in 2008, and 1320 and 837 euros respectively. DISCUSSION AND CONCLUSION: The average cost for radical hysterectomy was highest for robotic, followed by standard laparoscopy, and least for laparotomy. However, over only 2 years of use, this difference tends to decrease. Medico-economic impact is the main restraint for robotic assistance development, and needs to be assessed permanently.


Einstein, M. H. and L. W. Rice (2012). “Current surgical management of endometrial cancer.” Hematology/Oncology Clinics of North America 26(1): 79-91.

Despite being the most common gynecologic cancer in developed countries, there are many unanswered questions regarding optimal surgical management of endometrial cancer, including who should undergo surgical staging. There is evidence supporting the lower complication rate achieved with laparoscopic surgery compared with traditional open staging and building evidence to support laparoscopic-assisted robotic surgery for early endometrial cancer. Surgery plays an important role in the treatment of advanced stage disease, with retrospective studies showing some benefit to optimal cytoreduction. This review discusses the role of surgery in the management of endometrial cancer, with an emphasis on current controversies.


Gimferrer, M. C. (2011). “Surgical treatment of endometrial cancer.” Current Women’s Health Reviews 7(4): 317.

Koehler, C., E. Gottschalk, et al. (2012). “From laparoscopic assisted radical vaginal hysterectomy to vaginal assisted laparoscopic radical hysterectomy.” BJOG: An International Journal of Obstetrics and Gynaecology 119(2): 254-262.

Radical hysterectomy with pelvic lymphadenectomy is the standard surgical treatment for patients with early stage cervical cancer. The majority of radical hysterectomies are performed with the open technique. However, laparoscopic, combined laparoscopic and vaginal, and robotic-assisted approaches may also be used. Compared with the abdominal radical hysterectomy (ARH), laparoscopic techniques are associated with less blood loss, shorter hospital stay, better cosmesis, and faster recovery. A further breakthrough in laparoscopic technique can only be made if safety and oncological clearance are comparable with ARH. We describe the technique and results of laparoscopic assisted radical vaginal hysterectomy and the transition to vaginal assisted laparoscopic radical hysterectomy. © 2011 RCOG.


Lu, D., Z. Liu, et al. (2012). “Robotic assisted surgery for gynaecological cancer.” Cochrane Database of Systematic Reviews 1: CD008640.

BACKGROUND: Robotic surgery is the latest innovation in the field of minimally invasive surgery. Robotic surgical systems have been used to perform surgery for endometrial, cervical cancer and ovarian cancer. There is mounting evidence which demonstrates the feasibility and safety of robotic surgery for gynaecological oncology. OBJECTIVES: To evaluate the evidence for and against robotic assisted surgery in gynaecological cancer. SEARCH METHODS: We searched the Cochrane Gynaecological Cancer Review Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 2), MEDLINE and EMBASE (up to July 2010) and citation lists of relevant publications. SELECTION CRITERIA: All randomised controlled trials (RCTs) comparing robotic assisted surgery for gynaecological cancer to laparoscopic or open surgical procedures as well as RCTs comparing different types of robotic assistants. DATA COLLECTION AND ANALYSIS: Two review authors independently screened studies for inclusion. No RCTs were identified, therefore data collection and analysis could not be performed. MAIN RESULTS: No studies were found that met the inclusion criteria. Controlled clinical trials (CCTs) are summarised and analysed, but are not discussed in the main body of the review as they present a high risk of bias. AUTHORS’ CONCLUSIONS: Well-designed RCTs are required as only low quality evidence from CCTs is available. These studies support the use of robotic assisted surgery for endometrial cancer and cervical cancer, but these findings present a high risk of bias.


Nezhat, F. R., S. C. Chang-Jackson, et al. (2012). “Robotic-assisted laparoscopic transection and repair of an obturator nerve during pelvic lymphadenectomy for endometrial cancer.” Obstetrics and Gynecology 119(2 Pt 2): 462-464.

BACKGROUND: : Obturator nerve injury may occur in gynecologic surgery, particularly in cases in which extensive pelvic sidewall retroperitoneal dissection is performed. The lack of tactile feedback from the robotic surgical system may contribute to obturator nerve injury. If surgical division occurs, microsurgical end-to-end anastomosis of the obturator nerve may be performed. CASE: : A 76-year-old woman with stage IA endometrial adenocarcinoma sustained a left obturator nerve transection during pelvic lymphadenectomy that was recognized immediately. Robotic-assisted laparoscopic repair was performed successfully, with the patient experiencing no residual neuropathy 6 months postoperatively. CONCLUSION: : Robotic-assisted laparoscopic repair is feasible for the treatment of obturator nerve injury.


GYN_General       (5)


Chai, T. C. (2012). “Are costs for robotic assisted sacrocolpopexy lower than those for open sacrocolpopexy?” Journal of Urology 187(2): 644-645.


Ercoli, A., M. D’Asta, et al. (2012). “Robotic treatment of colorectal endometriosis: technique, feasibility and short-term results.” Human Reproduction.

BACKGROUNDDeep infiltrating endometriosis (DIE) is a complex disease that impairs the quality of life and the fertility of women. Since a medical approach is often insufficient, a minimally invasive approach is considered the gold standard for complete disease excision. Robotic-assisted surgery is a revolutionary approach, with several advantages compared with traditional laparoscopic surgery.METHODSFrom March 2010 to May 2011, we performed 22 consecutive robotic-assisted complete laparoscopic excisions of DIE endometriosis with colorectal involvement. All clinical data were collected by our team and all patients were interviewed preoperatively and 3 and 6 months post-operatively and yearly thereafter regarding endometriosis-related symptoms. Dysmenorrhoea, dyschezia, dyspareunia and dysuria were evaluated with a 10-point analog rating scale.RESULTSThere were 12 patients, with a median larger endometriotic nodule of 35 mm, who underwent segmental resection, and 10 patients, with a median larger endometriotic nodule of 30 mm, who underwent complete nodule debulking by colorectal wall-shaving technique. No laparotomic conversions were performed, nor was any blood transfusion necessary. No intra-operative complications were observed and, in particular, there were no inadvertent rectal perforations in any of the cases treated by the shaving technique. None of the patients had ileostomy or colostomy. No major post-operative complications were observed, except one small bowel occlusion 14 days post-surgery that was resolved in 3 days with medical treatment. Post-operatively, a statistically significant improvement of patient symptoms was shown for all the investigated parameters.CONCLUSIONSTo our knowledge, this is the first study reporting the feasibility and short-term results and complications of laparoscopic robotic-assisted treatment of DIE with colorectal involvement. We demonstrate that this approach is feasible and safe, without conversion to laparotomy.


Matthews, C. A. (2012). “The promise of robotics in urogynecology.” Int Urogynecol J.


Moreno Sierra, J., E. Ortiz Oshiro, et al. (2012). “Robotic-Assisted Laparoscopic Sacrocolpopexy: Temporary Phenomenon or a New Consolidated Technique.” Urologia Internationalis.

No abstract available.


Umoh, U. E. and L. A. Arya (2012). “Surgery in urogynecology.” Minerva Medica 103(1): 23-36.

Pelvic floor disorders, including stress urinary incontinence and pelvic organ prolapse, are common conditions that have a significant negative impact on the well-being and quality of life of women. Several surgical options exist for women who have failed conservative management of stress urinary incontinence and pelvic organ prolapse. The aim of this review is to outline the most common and current surgical procedures employed by urogynecologist for the treatment of these conditions and review their indications, success rates and common complications. Surgical options for stress urinary incontinence include retropubic colposuspension, slings, and urethral bulking injections. Midurethral slings are minimally invasive procedures with low rates of complications and good outcomes and as such have become the mainstay of surgical treatment for SUI. However, in patients for whom the risk of anesthesia and surgery is too high, urethral bulking injections may provide a safer alternative. A thorough understanding of the site of prolapse occurrence is necessary to provide the best surgical correction for women. There is growing recognition that correction of apical prolapse is important in decreasing the risk of prolapse recurrence. Apical prolapse can be repaired via vaginal or abdominal routes. Vaginal procedures include uterosacral ligament suspension, sacrospinous ligament suspension and obliterative procedures. Abdominal procedures include the abdominal sacrocolpopexy which can be performed by open laparotomy or with laparoscopic or robotic assistance. The use of mesh in vaginal prolapse repair is currently a heavily debated subject and more research is needed to establish its safety and efficacy. Urogynecologists are armed with a variety of surgical options for the treatment of pelvic floor disorders. The best surgery will always take into account the specific patient characteristics and her goals for surgery.